Concept: Maxillary central incisor

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The aim of the study was to test the hypothesis that the gene defect causing congenital absence of maxillary lateral incisors also causes narrowing of the dentition. A total of 81 patients with one or two congenitally missing lateral incisors were retrieved; 52 (64.2 per cent) patients presented bilateral agenesis, whereas 29 (35.8 per cent) had unilateral agenesis. The control group consisted of 90 consecutively treated patients. The largest mesiodistal crown dimension for all teeth, except for the maxillary second and third molars, was measured on plaster casts using a digital caliper to the nearest 10th of a millimetre. Statistical testing was performed using the analysis of variance model (P < 0.05) to test for differences in the mesiodistal dimension between the sample and the control group. Significance has been assessed using a P-value threshold level of 5 per cent. Agenesis of maxillary lateral incisors was found to be a significant predictor of tooth size. Patients who were missing maxillary lateral incisors had smaller teeth compared to control subjects, except for the maxillary right and left first molars. This finding was true for both unilateral and bilateral lateral incisor agenesis. Interaction between maxillary lateral incisor agenesis and gender was not significant. Patients with congenitally missing lateral incisors have narrower teeth than patients without any dental anomalies, except for maxillary first molars. A higher prevalence of microdontic contralateral incisors was found in patients with unilateral agenesis with respect to the control group.

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External cervical resorption is the loss of dental hard tissue as a result of odontoclastic action; it usually begins on the cervical region of the root surface of the teeth. This case report demonstrates an external cervical resorption in a maxillary central incisor of a 24-year-old male patient. After surgical intervention and root canal treatment, the resorption was subsequently sealed with mineral trioxide aggregate. The 18 months follow-up demonstrates no pathological changes on clinical and radiographic examination. This case report presents a treatment strategy that might improve the healing outcomes for patients with external cervical resorption.

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The first-line treatment of non-restorable traumatically injured or carious deciduous teeth is extraction which may be a curse for the future dentition as well as social activity of a child. Various therapeutic modalities from removable partial dentures to fixed space maintainer can be used for replacement of such lost teeth. Two types of fixed aesthetic space maintainers for replacing premature loss of maxillary deciduous incisors in 4-year-old children are discussed.

- Primary tooth impaction is a rare phenomenon when compared to permanent teeth impaction. The purpose of this report is to present a 5-year-old Chinese girl who exhibited impaction of tooth 51, its unusual consequence on the permanent successor tooth and its comprehensive management. Her parents revealed that at 6 months of age, the patient had fallen from her bed and struck her face on the floor; however, there were no teeth present in the oral cavity. The intraoral examinations identified a bony-like projection on the buccal aspect of the alveolus in the 51 region. Radiographic examination revealed that tooth 51 exhibited an unfavourable orientation, with the crown directed towards the palate. Therefore, the impacted tooth 51 was surgically removed, and two years later tooth 11 erupted into the oral cavity with an indentation on its incisal aspect, which resembled the crown of the primary teeth, thus giving the appearance of a tooth within a tooth or ‘dens in dente’. Subsequently, enameloplasty and composite resin build-up was performed on tooth 11 for aesthetic reasons. It is very unusual to have the clinical crowns of both primary and permanent teeth in such close proximity within the alveolar bone, and the present case is a good example to emphasize that trauma to the primary teeth is of considerable importance due to the close proximity of the primary teeth to permanent tooth germs.

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This case report demonstrates a novel treatment approach to deal with a severely rotated and impacted upper central incisor in an adolescent patient. A precision custom-made gold attachment was fabricated from a prototype using cone beam computerized tomograph (CBCT) scan data and then used to align and de-rotate the impacted central incisor.

This study explored the relationship between the thickness of bone and soft tissue along the labial and palatal aspect of maxillary central incisors. The influence of overall socket width, labiopalatal positioning of the incisor on the bone, and soft tissue thickness were also investigated.

BACKGROUND: To determine the association between social deprivation and the prevalence of caries (including caries lesions restricted to enamel) and enamel fluorosis in areas that are served by either fluoridated or non-fluoridated drinking water using clinical scoring, remote blinded, photographic scoring for caries and fluorosis. The study also aimed to explore the use of remote, blinded methodologies to minimize the effect of examiner bias. METHODS: Subjects were male and female lifetime residents aged 11–13 years. Clinical assessments of caries and fluorosis were performed on permanent teeth using ICDAS and blind scoring of standardized photographs of maxillary central incisors using TF Index (with cases for fluorosis defined as TF > 0). RESULTS: Data from 1783 subjects were available (910 Newcastle, 873 Manchester). Levels of material deprivation (Index of Multiple Deprivation) were comparable for both populations (Newcastle mean 35.22, range 2.77-78.85; Manchester mean 37.04, range 1.84-84.02). Subjects in the fluoridated population had significantly less caries experience than the non-fluoridated population when assessed by clinical scores or photographic scores across all quintiles of deprivation for white spot lesions: Newcastle mean DMFT 2.94 (clinical); 2.51 (photo), Manchester mean DMFT 4.48 (clinical); 3.44 (photo) and caries into dentine (Newcastle Mean DMFT 0.65 (clinical); 0.58 (photo), Manchester mean DMFT 1.07 (clinical); 0.98 (photo). The only exception being for the least deprived quintile for caries into dentine where there were no significant differences between the cities: Newcastle mean DMFT 0.38 (clinical); 0.36 (photo), Manchester mean DMFT 0.45 (clinical); 0.39 (photo). The odds ratio for white spot caries experience (or worse) in Manchester was 1.9 relative to Newcastle. The odds ratio for caries into dentine in Manchester was 1.8 relative to Newcastle. The odds ratio for developing fluorosis in Newcastle was 3.3 relative to Manchester. CONCLUSIONS: Water fluoridation appears to reduce the social class gradient between deprivation and caries experience when considering caries into dentine. However, this was associated with an increased risk of developing mild fluorosis. The use of intra-oral cameras and remote scoring of photographs for caries demonstrated good potential for blinded scoring.

Successful breastfeeding is dependent upon an infant’s ability to correctly latch onto a mother’s breast. If an infant is born with oral soft tissue abnormalities such as tongue-tie or lip-tie, breastfeeding may become challenging or impossible. During the oral evaluation of an infant presenting with breastfeeding problems, one area that is often overlooked and undiagnosed and, thus, untreated is the attachment of the upper lip to the maxillary gingival tissue. Historically, this tissue has been described as the superior labial frenum, median labial frenum, or maxillary labial frenum. These terms all refer to a segment of the mucous membrane in the midline of the upper lip containing loose connective tissue that inserts into the maxillary arch’s loose, unattached gingival or tight, attached gingival tissue. There is no muscle contained within this tissue. In severe instances, this tissue may extend into the area behind the upper central incisors and incisive papilla. The author has defined and identified the restrictions of mobility of this tissue as a lip-tie, which reflects the clinical attachment of the upper lip to the maxillary arch. This article discusses the diagnosis and classifications of the lip-tie, as it affects an infant’s latch onto the mother’s breast. As more and more women choose to breastfeed, lip-ties must be considered as an impediment to breastfeeding, recognizing that they can affect a successful, painless latch and milk transfer.

To evaluate alveolar bone support around cleft-adjacent maxillary central incisors (U1) in patients with unilateral cleft lip, alveolus and palate (UCLAP) in the late mixed dentition and to investigate the correlation between the alveolar bone thickness (ABT) and tooth inclination.